RESUMEN
Background: Moral hazard is the increased likelihood of loss driven by insured behavior, which is a major the challenges faced by the insurance system. Therefore, the purpose of this study is to review the concept of moral hazard and
its types, causes, consequences and control measures
Methods: This study was conducted through review, utilizing articles related to the subject in Springer's published texts, valid sites and databases such as: Google Scholar, Magiran, Medline, Springer, SID, Scopus and PubMed. The information utilized was collected from 1960-2016. Databases were searched using keywords of moral hazard in health services, causes of hazards, types of hazards in health systems, the consequences of hazards, the ways of controlling hazards, health insurance, moral hazards and health insurance
Results: The results showed that the third party [insurer] in health insurance contracts, paying a high share of treatment costs, mitigates the motivation for the behaviors of disease prevention, and prevents harm or disease, i.e. Because the patient pays only a fraction of the cost, it has devastating consequences such as increasing insurer costs and the health system, reducing welfare, wasting resources, reducing insurance coverage, and so forth
Conclusions: Identifying various types of moral hazards, their causes and consequences in determining control strategies and reducing moral hazard and preventing undesirable outcomes are effective
RESUMEN
Background: Insurance deductions are not only caused to failure to achieve the paid costs from the provided services but also are caused to the inefficiency of hospitals. So, this research was conducted to determine the amounts and reasons of insurance deductions in patients' bills of Tamin Ejtemaei
Methods: This descriptive-practical and retrospective study was conducted in the second season of 2012. The statistical population included records of hospitalized patients [discharged] covered by Tamin Ejtemaei insurance that was conducted as census. The data were collected by using a check list which its validity had been confirmed by experts. The collected information was analyzed through the Excell software and descriptive statistics. Information related to the proposed solution was collected by using group discussion
Results: The amount of applied deductions by Tamin Ejtemaei insurance organization was 47408.62 [dollar sign] [1[dollar sign] = 12050 Rials]. As bills of hospitalized patients' records. The mostly applied deductions were respectively related to equipment of surgery-room, the type of bed during hospital stay, and surgeon fees, however, the main part of these deductions was due to the premium [incompatibility between the price on request and the price of equipment applied for patient] as well as additional request [not consideration of the authorized tariff] by hospital
Conclusion: The hospital efficiency and care therapy quality can be improved by more accurate and better perception of the amount and reasons of insurance deductions and correct management of them
RESUMEN
Background: Paving the way for having equitable access to medical intervention programs is the most important action that a health system can take in realizing social justice. This study aims at examining proper distribution of specialist physicians as an strategy towards realizing justice and equity in access to and use of health services as well as providing recommendations for policy-makers
Methods: This is a review-narrative and bibliographic research that used databases consisting of Magiran, Irandoc, Iranmedex, SID, PubMed, Scopus, EMBASE, Direct Science with the key words including Specialists, Health, Equity, Accessibility, Health system and Human resources. The data were collected from 1990 to 2015
Results: There are evidences of regions in the world that still are lacking sufficient number of physician workforce and are not only faced with challenges of recruiting, but also with retention of specialist physicians. In fact, migration of human workforce from deprived regions to more organized and prosperous parts has been a factor influencing workforce shortage in these regions; thereby it adds further problem of recruitment and retention of specialist workforce
Conclusions: Human workforce distribution [Specialist or non-specialists] has direct effects on realizing equity and justice in health system; it also influences economy of a given country indirectly. On the other hand, compensation is one of the important incentives that drives workforce behavior and makes them more inclined towards working in deprived regions. Taking the above mentioned ideas, it is recommended for the health system to use more economic incentives and insure proper distribution that fits individuals' needs. Using various tax policies in deprived, wealthy, and generally different geographical regions is one of the most important incentives available to leverage this purpose